OpenOnco · Breast · TNBC met 2L · Sacituzumab govitecan (ASCENT)
← Back to galleryFeedback on this case
Synthetic educational example. Do not self-treat: a qualified treating physician must verify the sources, patient data, contraindications, and final plan.
OpenOnco · Treatment Plan
Treatment plan — Invasive breast cancer
PLAN-BREAST-TNBC-2L-SACI-001-V1 · v1 · 2026-08-18
Patient
BREAST-TNBC-2L-SACI-001 · Algorithm: ALGO-BREAST-TNBC-2L
DiagnosisInvasive breast cancer
MOH / ICD-10C50
ICD-O-38500/3; C50.9
StageIV
Histologyinvasive_ductal_carcinoma_NST

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks
✅ Covered biomarkers (matched in KB)
BiomarkerVariantESCATEvidenceClinical significanceDrugsSources
No clinically actionable variants matched in this profile.
⚠️ Not included in plan
BiomarkerStatus
BIO-ERExcluded (negative)
BIO-PRExcluded (negative)
BIO-HER2-SOLIDExcluded (negative)
BIO-PDL1-CPSBIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Standard plan
★ DEFAULT
Indication
IND-BREAST-TNBC-2L-SACITUZUMAB
Regimen
Sacituzumab govitecan monotherapy (TNBC ≥2L; HR+/HER2- ≥3L)
Drugs + NSZU
  • Sacituzumab govitecan (DRUG-SACITUZUMAB-GOVITECAN) 10 mg/kg IV · Days 1, 8 of 21-day cycle, until progression · IV ✗ Not registered in UA
Supportive care
SUP-G-CSF-PRIMARY-PROPHYLAXIS-PROSTATE, SUP-BONE-HEALTH-PROSTATE
Reason
Primary current-line option selected by ALGO-BREAST-TNBC-2L at step 4.

Other current-line alternatives (3 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
Standard plan
Indication
IND-BREAST-TNBC-2L-BRCA-OLAPARIB
Regimen
Olaparib monotherapy (BRCA-mutant HER2- breast: metastatic OR adjuvant high-risk early)
Drugs + NSZU
  • Olaparib (DRUG-OLAPARIB) 300 mg PO BID continuous · Until progression (metastatic) or 1 year (OlympiA adjuvant) · PO ⚠ NSZU — not for this indication
Supportive care
SUP-BONE-HEALTH-PROSTATE
Reason
Current-line alternative presented for HCP consideration
Standard plan
Indication
IND-BREAST-TNBC-2L-BRCA-TALAZOPARIB
Regimen
Olaparib monotherapy (BRCA-mutant HER2- breast: metastatic OR adjuvant high-risk early)
Drugs + NSZU
  • Olaparib (DRUG-OLAPARIB) 300 mg PO BID continuous · Until progression (metastatic) or 1 year (OlympiA adjuvant) · PO ⚠ NSZU — not for this indication
Supportive care
SUP-BONE-HEALTH-PROSTATE
Reason
Current-line alternative presented for HCP consideration
Standard plan
Indication
IND-BREAST-TNBC-2L-T-DXD-HER2-LOW
Regimen
T-DXd monotherapy (HER2+ metastatic 2L+, also HER2-low metastatic)
Drugs + NSZU
  • Trastuzumab deruxtecan (T-DXd) (DRUG-TRASTUZUMAB-DERUXTECAN) 5.4 mg/kg IV · Day 1 of 21-day cycle, continuous until progression · IV ✓ NSZU covered
Supportive care
SUP-BONE-HEALTH-PROSTATE
Reason
Current-line alternative presented for HCP consideration

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks
IDNamePriorityCategoryWhere to orderNeeded for
TEST-CECT-CAPCECT chest/abdomen/pelvisCriticalimagingall tracks
TEST-ER-PR-IHCER + PR immunohistochemistry on tumorCriticalCSD Lab ✓ (code TBC)all tracks
TEST-HER2-IHC-FISHHER2 IHC + reflex FISH on tumorCriticalCSD Lab ✓ (code TBC)all tracks
TEST-GERMLINE-BRCA-PANELGermline BRCA1/2 + HRR panel sequencingStandardCSD Lab: M089all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track
  • HER2-ultralow breast cancer (IHC > 0 < 1+; faint/incomplete membrane staining ≤10% of tumor cells) — a sub-tier between IHC 0 and IHC 1+ not part of standard ASCO/CAP scoring. DESTINY-Breast06 (Bardia 2024 ASCO plenary) extended T-DXd benefit beyond HER2-low to HER2-ultralow HR+ metastatic breast post-endocrine + CDK4/6i, chemo-naive in the metastatic setting (HER2-low cohort mPFS 13.2 vs 8.1 mo, HR 0.62; HER2-ultralow exploratory n=153 mPFS 13.2 vs 8.3 mo, HR 0.78). FDA label expansion anticipated 2026 — candidate RF until pivotal-trial Source SRC-DESTINY-BREAST06-BARDIA-2024 ingested.
    Candidate RF — DESTINY-Breast06 trial-Source not yet ingested (SRC-DESTINY-BREAST06-BARDIA-2024 flagged in BIO-HER2-ULTRALOW notes). Pathology re-scoring required: ASCO/CAP 2018 / 2023 guideline does not formally distinguish ultralow from…
    RF-BREAST-HER2-ULTRALOW-CANDIDATESRC-NCCN-BREAST-2025SRC-ESMO-BREAST-METASTATIC-2024
  • HBV/HCV/HIV serology + dental evaluation pre-bisphosphonate/denosumab + DPYD genotyping for capecitabine-containing regimens (EU practice).
    Cross-disease HBV reactivation handled by RF-UNIVERSAL-HBV-REACTIVATION- RISK. DPYD deficiency screening unique to fluoropyrimidine-containing regimens; severe / fatal toxicity in homozygous deficient patients — EU/EMA-recommended pre-test.
    RF-BREAST-INFECTION-SCREENINGSRC-NCCN-BREAST-2025SRC-ESMO-BREAST-EARLY-2024

CONTRA-AGGRESSIVE

Hard contraindications to escalation

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Sacituzumab govitecan monotherapy (TNBC ≥2L; HR+/HER2- ≥3L)
21-day cycles × Continuous until progression

Standard plan

Induction · Olaparib monotherapy (BRCA-mutant HER2- breast: metastatic OR adjuvant high-risk early)
28-day cycles × Adjuvant: 12; Metastatic: continuous until progression

Standard plan

Induction · T-DXd monotherapy (HER2+ metastatic 2L+, also HER2-low metastatic)
21-day cycles × Continuous until progression or unacceptable toxicity

MDT brief

Discussion questions (1, 0 blocking)

MDT talk tree (1 steps)

#OwnerTopicAction
1molecular_geneticistBiomarker status What is the status of BRCA1/BRCA2 germline pathogenic variant (BIO-BRCA1-BRCA2-GERMLINE)? It is required by track(s): IND-BREAST-TNBC-2L-BRCA-OLAPARIB, IND-BREAST-TNBC-2L-BRCA-TALAZOPARIB. Expected value: pathogenic OR likely-pathogenic germline variant.

Skills (recommended) — for consideration (1)

  • Molecular geneticist / molecular oncologist recommended
    Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
    Owns: OQ-BIOMARKER-BRCA1-BRCA2-GERMLINE

Data quality

Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.
  • Biomarker coverage: 1/2 known (50%), 1 missing, 0 default-track gaps
  • Unevaluated RedFlags: RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-ATM-CONFIRMED-CARRIER, RF-ATM-FAMILY-HISTORY-SUSPICION, RF-BARD1-CONFIRMED-CARRIER, RF-BARD1-FAMILY-HISTORY-SUSPICION, RF-BLM-CONFIRMED-CARRIER, RF-BRCA-CONFIRMED-CARRIER, RF-BRCA-HBOC-FAMILY-HISTORY-SUSPICION, RF-BREAST-AKT1-E17K-ACTIONABLE, RF-BREAST-AKT1-E17K-CAPIVASERTIB-CANDIDATE, RF-BREAST-BRCA-GERMLINE-ACTIONABLE, RF-BREAST-CDH1-LOBULAR-CANDIDATE, RF-BREAST-EARLY-STAGE, RF-BREAST-ESR1-MUT-ACTIONABLE, RF-BREAST-ESR1-Y537S-D538G-CANDIDATE, RF-BREAST-FRAILTY-AGE, RF-BREAST-HER2-AMP-ACTIONABLE, RF-BREAST-HER2-LOW-ACTIONABLE, RF-BREAST-HER2-ULTRALOW-CANDIDATE, RF-BREAST-HIGH-RISK-BIOLOGY, RF-BREAST-INFECTION-SCREENING, RF-BREAST-ORGAN-DYSFUNCTION, RF-BREAST-OVARIAN-HRD-ASSAY-DISTINCTION, RF-BREAST-PIK3CA-COALT-INAVOLISIB-CANDIDATE, RF-BREAST-PIK3CA-MUT-ACTIONABLE, RF-BREAST-STAGE-IV-METASTATIC, RF-BREAST-TNBC, RF-BREAST-TRANSFORMATION-PROGRESSION, RF-CASCADE-BRCA-FDR-POSITIVE, RF-CASCADE-LFS-FDR-POSITIVE, RF-CHEK2-CONFIRMED-CARRIER, RF-CHEK2-FAMILY-HISTORY-SUSPICION, RF-CHRONIC-SEVERE-OBESITY-BMI40-PREVENTION, RF-CHRONIC-T2DM-CANCER-RISK-PREVENTION, RF-COWDEN-CONFIRMED-CARRIER, RF-COWDEN-FAMILY-HISTORY-SUSPICION, RF-HDGC-CDH1-CONFIRMED-CARRIER, RF-IATROGENIC-COMBINED-HRT-PREVENTION, RF-IATROGENIC-IODINE131-SECONDARY-PREVENTION, RF-IATROGENIC-LONG-TERM-HRMNL-CONTRACEPTION-PREVENTION, RF-IATROGENIC-PRIOR-RADIATION-PREVENTION, RF-LI-FRAUMENI-CONFIRMED-CARRIER, RF-LI-FRAUMENI-FAMILY-HISTORY-SUSPICION, RF-LIFESTYLE-ALCOHOL-CANCER-PREVENTION, RF-LIFESTYLE-OBESITY-CANCER-PREVENTION, RF-LIFESTYLE-SEDENTARY-PREVENTION, RF-LIFESTYLE-SUGARY-BEVERAGES-PREVENTION, RF-NBN-CONFIRMED-CARRIER, RF-NF1-CONFIRMED-CARRIER, RF-NF1-FAMILY-HISTORY-SUSPICION, RF-OCC-IONIZING-RADIATION-PREVENTION, RF-OCC-SHIFTWORK-CIRCADIAN-PREVENTION, RF-PALB2-CONFIRMED-CARRIER, RF-PALB2-FAMILY-HISTORY-SUSPICION, RF-PAN-ATM-CHEK2-CDK12-PARPI-CANDIDATE, RF-PAN-BRCA-SOMATIC-PARPI-CANDIDATE, RF-PAN-PALB2-PARPI-CANDIDATE, RF-PEUTZ-JEGHERS-CONFIRMED-CARRIER, RF-PEUTZ-JEGHERS-FAMILY-HISTORY-SUSPICION, RF-RAD51C-D-CONFIRMED-CARRIER, RF-RAD51C-D-FAMILY-HISTORY-SUSPICION, RF-REPRODUCTIVE-BREAST-ENDOMETRIAL-PREVENTION, RF-REPRODUCTIVE-DES-IN-UTERO-EXPOSURE-PREVENTION, RF-REPRODUCTIVE-LATE-FIRST-PREGNANCY-PREVENTION, RF-REPRODUCTIVE-OCP-LONG-TERM
Missing biomarkerLabelMDT ownerDefault trackRequired byNext action
BIO-BRCA1-BRCA2-GERMLINEBRCA1/BRCA2 germline pathogenic variantmolecular_geneticistnoIND-BREAST-TNBC-2L-BRCA-OLAPARIB, IND-BREAST-TNBC-2L-BRCA-TALAZOPARIBVerify result, method, specimen, and report date before sign-off. Expected/constraint: pathogenic OR likely-pathogenic germline variant
Technical MDT skill metadata (1/16 activated in this plan)
All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).
Specialistskill_idVersionLast reviewedSign-offsDomain
Cellular therapy specialist (CAR-T)cellular_therapy_specialistv0.1.02026-04-250cellular_therapy
Clinical pharmacistclinical_pharmacistv0.1.02026-04-250clinical_pharmacy
Hematologist / oncohematologisthematologistv0.1.02026-04-250hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)hematopathologistv0.1.02026-04-250hematopathology
Infectious disease / hepatologyinfectious_disease_hepatologyv0.1.02026-04-250infectious_diseases
Medical oncologist (solid-tumor chemotherapist)medical_oncologistv0.1.02026-04-250solid_oncology
Molecular geneticist / molecular oncologistmolecular_geneticistv0.1.02026-04-250molecular_oncology
Palliative carepalliative_carev0.1.02026-04-250palliative_care
Pathologist (general)pathologistv0.1.02026-04-250pathology
Primary care / family physicianprimary_carev0.1.02026-04-250primary_care
Psycho-oncologistpsychologistv0.1.02026-04-250psychosocial
Radiation oncologistradiation_oncologistv0.1.02026-04-250radiation_oncology
Radiologistradiologistv0.1.02026-04-250diagnostic_imaging
Social worker / case managersocial_worker_case_managerv0.1.02026-04-250psychosocial
Surgical oncologistsurgical_oncologistv0.1.02026-04-250surgical_oncology
Transplant specialist (BMT)transplant_specialistv0.1.02026-04-250cellular_therapy

Sources cited

Experimental options (clinical trials)

Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-08-18.
NCTTitlePhaseStatusSponsorUASignalsEligibility (excerpt)
NCT06790264Exploring the Tumor Micro-Environment with 68Ga-FAPi-46 PET/CT in Breast CancerNARECRUITINGEuropean Institute of OncologySingle country
NCT06716073Long-Term Outcomes of Endoscopic-assisted vs Conventional Breast-conserving Surgery in Breast Cancer Patients After Neoadjuvant Therapy: a Randomized, Multicenter, Open Label, Non-inferiority TrialNARECRUITINGSun Yat-Sen Memorial Hospital of Sun Yat-Sen UniversitySurrogate endpoint only Single country
NCT05861271Adjuvant Pyrotinib and Capecitabine For HER2 Positive Micro Invasive Breast CancerPHASE2RECRUITINGFudan UniversitySurrogate endpoint only Single country
NCT06807502Evaluation of Circulating Tumor Cells (CTC) Relevance in Breast Cancer Follow-up Using the ScreenCell DeviceNARECRUITINGScreenCellSingle country
NCT04790305Effect of Huaier Granule on Adjuvant Treatment for High-risk Early-stage Triple-negative Breast CancerPHASE4RECRUITINGFudan UniversitySurrogate endpoint only Single country
NCT07003009Immun Checkpoint Washout in Patients With Invasive Ductal Breast CancerNARECRUITINGIstanbul Training and Research HospitalSmall N (<50) Single country
NCT06823414Endoscopy/Robotic Assisted Nipple Skin Sparing MastectomyN/ARECRUITINGAlejandra García-NovoaSingle country
NCT03201861Addition of Cisplatin to Adjuvant Chemotherapy for Early Stage Breast Cancer in High-Risk WomenPHASE3RECRUITINGRenJi HospitalSurrogate endpoint only Single country
NCT07260188Organoids From Breast Cancer Patients Treated With Neoadjuvant TherapyN/ARECRUITINGIstituti Clinici Scientifici Maugeri SpASingle country
NCT02945579Multicenter Trial for Eliminating Breast Cancer Surgery or Radiotherapy in Exceptional Responders to Neoadjuvant Systemic TherapyNARECRUITINGM.D. Anderson Cancer CenterSingle country

Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.

Option availability in Ukraine

Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).
OptionUA registrationNSZUCost orientationAccess pathway
Standard plan
Sacituzumab govitecan monotherapy (TNBC ≥2L; HR+/HER2- ≥3L) (REG-SACITUZUMAB)
1/1 component drug(s) not registered in Ukraine +1
✗ not registered✗ out-of-pocket₴-? — verify pathwaynot recorded
Standard plan
Olaparib monotherapy (BRCA-mutant HER2- breast: metastatic OR adjuvant high-risk early) (REG-OLAPARIB-BREAST)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Standard plan
Olaparib monotherapy (BRCA-mutant HER2- breast: metastatic OR adjuvant high-risk early) (REG-OLAPARIB-BREAST)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Standard plan
T-DXd monotherapy (HER2+ metastatic 2L+, also HER2-low metastatic) (REG-TDXD-METASTATIC)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Trial · NCT06790264
Exploring the Tumor Micro-Environment with 68Ga-FAPi-46 PET/CT in Breast Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06716073
Long-Term Outcomes of Endoscopic-assisted vs Conventional Breast-conserving Surgery in Breast Cancer Patients After Neoadjuvant Therapy: a Randomized, Multicenter, Open Label, Non-inferiority Trial
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT05861271
Adjuvant Pyrotinib and Capecitabine For HER2 Positive Micro Invasive Breast Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06807502
Evaluation of Circulating Tumor Cells (CTC) Relevance in Breast Cancer Follow-up Using the ScreenCell Device
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT04790305
Effect of Huaier Granule on Adjuvant Treatment for High-risk Early-stage Triple-negative Breast Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07003009
Immun Checkpoint Washout in Patients With Invasive Ductal Breast Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06823414
Endoscopy/Robotic Assisted Nipple Skin Sparing Mastectomy
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT03201861
Addition of Cisplatin to Adjuvant Chemotherapy for Early Stage Breast Cancer in High-Risk Women
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07260188
Organoids From Breast Cancer Patients Treated With Neoadjuvant Therapy
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT02945579
Multicenter Trial for Eliminating Breast Cancer Surgery or Radiotherapy in Exceptional Responders to Neoadjuvant Systemic Therapy
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-08-18.